Giving Compass' Take:

• This case study explores the practices of two health conversion organizations working to improve the lives in rural communities in New England. 

• How can other foundations learn from these organizations? What organizations in your area need more support for their local work?

• Learn about rural LGBTQ giving. 

In the tiny town of Gorham (population 2,626) in New Hampshire’s rugged North Country, Cathy McDowell is laser focused on improving social emotional development for children ages 0 to 8 in remote Coös County, the place she’s called home for 40 years. Just over a hundred miles away in the city of Waterville, Maine (16,406), Fran Mullin works from a donated office in the basement of a local hospital to ensure that residents in her town always have enough to eat.

Both New Hampshire and Maine are known for their cultures of rugged individualism, and although Cathy and Fran would no doubt go it alone in their respective quests if necessary, each knows that she doesn’t have to. The investment of private foundations in both of their states have supported their efforts to tap solidly into the networks and connections that lie just under the surface in almost any rural community and help these networks grow.

These two women will likely never meet most of the people whose lives are changed from the ripples emanating from their work. They’d be hard-pressed to quantify all of their results into rigid columns of numbers, but that’s okay. In communities like these, you can feel the difference they’re making — and so can the foundations that fund them.

The states of New Hampshire and Maine share more than just a border. Both states have large tracts of rural landscapes, and in Maine, more people live in rural areas than urban ones. The urban centers are anchored in the southern ends of the states, and in turn serve as the northernmost outposts of the massive New England urban corridor. As you travel north, dense forests surround small towns that once thrived on sawmills and paper mills, now mostly shuttered. There are areas in both states that are essentially viewed as “unpopulated.”

In terms of ethnic diversity, both New Hampshire and Maine have predominantly white rural populations that are slowly becoming are more diverse. In the 2010 Census, Maine’s population was 94.4 percent white and 61.3 percent rural, making it the nation’s “most rural state.” In New Hampshire, the population was 93.9 percent white and 40 percent rural, per the 2010 Census. Yet, despite this high level of apparent homogeneity, different regions in each state — and even different small towns within them — have developed their own identities.

The northern reaches are attractive to nature lovers and outdoor adventure seekers, fueling tourist-driven economies in towns near lakes, rivers, or mountain peaks. Southern micropolitan cities attract daily commuters from surrounding hamlets. Farming and fisheries have remained economic anchors, although the closing of textile, shoe, paper and lumber mills have dealt severe blows to employment over the past two decades.

Operating in this setting are several statewide funders, including two health conversion foundations that were created from the sale of non-profit insurers to private companies. The Endowment for Health, formed in 1999 upon the sale of Blue Cross Blue Shield and headquartered in Concord, New Hampshire, is the state’s largest health foundation with $86 million in assets. To the east in Augusta, Maine, is the Maine Health Access Foundation with assets of $124 million, created in 2000 the sale of nonprofit insurer Maine Blue Cross-Blue Shield to the for profit insurer, Anthem.

Both foundations are dedicated to addressing the needs and promise of rural places. Both are de-facto rural funders because the decidedly rural nature of their respective states automatically brings rural issues to the forefront. Yet within this broad rural context each hold strategies that specifically target rural communities.

In terms of grantmaking in rural communities, both funders have specific strategies for addressing social determinants of health and improving health outcomes across their states, but each — at its heart — is bringing people together to identify problems and solutions. The core strategy at play is all about forging and leveraging human connections, so that everyone involved ultimately feels part of something bigger that’s worth a common effort.